CT angiography as a confirmatory test in diagnosis of brain death: comparison between three scoring systems

Şahin, Hilal; Pekçevik, Yeliz

doi:10.5152/dir.2014.14241

Cited by 16 publications

(8 citation statements)

References 23 publications

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“…In our study, the interobserver agreement among three reviewers with different levels of experience was found to be excellent in assessing the 4-point scoring systems and CTP, and good in stasis filling. Similarly, interobserver agreement for the 10-point, 7-point, and 4-point scoring systems were found to be high for all scales in previous studies ( 22 23 ). Concerning our study, the excellent compliance of CTA 4-point scoring systems could be explained by using the subtraction images.…”

Section: Discussionsupporting

confidence: 64%

Assessment of Cerebral Circulatory Arrest via CT Angiography and CT Perfusion in Brain Death Confirmation

Akdoğan¹,

Pekçevik

Şahin

et al. 2021

Korean J Radiol

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Objective To compare the utility of computed tomography perfusion (CTP) and three different 4-point scoring systems in computed tomography angiography (CTA) in confirming brain death (BD) in patients with and without skull defects. Materials and Methods Ninety-two patients clinically diagnosed as BD using CTA and/or CTP for confirmation were retrospectively reviewed. For the final analysis, 86 patients were included in this study. Images were re-evaluated by three radiologists according to the 4-point scoring systems that consider the vessel opacification on 1) the venous phase for both M4 segments of the middle cerebral arteries (MCAs-M4) and internal cerebral veins (ICVs) (A60-V60), 2) the arterial phase for the MCA-M4 and venous phase for the ICVs (A20-V60), 3) the venous phase for the ICVs and superior petrosal veins (ICV-SPV). The CTP images were independently reviewed. The presence of an open skull defect and stasis filling was noted. Results Sensitivities of the ICV-SPV, A20-V60, A60-V60 scoring systems, and CTP in the diagnosis of BD were 89.5%, 82.6%, 67.4%, and 93.3%, respectively. The sensitivity of A20-V60 scoring was higher than that of A60-V60 in BD patients ( p < 0.001). CTP was found to be the most sensitive method (86.5%) in patients with open skull defect ( p = 0.019). Interobserver agreement was excellent in the diagnosis of BD, in assessing A20-V60, A60-V60, ICV-SPV, CTP, and good in stasis filling (κ: 0.84, 0.83, 0.83, 0.83, and 0.67, respectively). Conclusion The sensitivity of CTA confirming brain death differs between various proposed 4-point scoring systems. Although the ICV-SPV is the most sensitive, evaluation of the SPV is challenging. Adding CTP to the routine BD CTA protocol, especially in cases with open skull defect, could increase sensitivity as a useful adjunct.

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Section: Discussionsupporting

confidence: 64%

Assessment of Cerebral Circulatory Arrest via CT Angiography and CT Perfusion in Brain Death Confirmation

Akdoğan¹,

Pekçevik

Şahin

et al. 2021

Korean J Radiol

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“…One of the advantages of CTP over more commonly used ancillary imaging test of CTA was the ability of CTP to demonstrate isolated brainstem death. While CTA is ubiquitously used and studied, [10][11][12][13][14]16,[19][20][21][22][23] it does not permit functional assessment of brainstem function. Radionuclide scan could, in principle, demonstrate the isolated brainstem death; however, the number of patients in our study was small and the poor spatial resolution of radionuclide scan could be a limitation.…”

Section: Discussionmentioning

confidence: 99%

The Role of Neuroimaging in the Determination of Brain Death

MacDonald

Stewart-Perrin

Shankar

2018

Journal of Neuroimaging

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BACKGROUND AND PURPOSEBrain death determination (BDD) is primarily a clinical diagnosis, where death is defined as the permanent loss of brainstem function. In scenarios where clinical examinations are inaccurate, ancillary imaging tests are required. The choice of ancillary imaging test is variable, but the common denominator for all of them is to establish a lack of cerebral blood flow. The purpose of this study was to compare the diagnostic accuracy and interrater reliability of different ancillary imaging tests used for BDD.METHODSArchival data were retrospectively analyzed for all patients who underwent any ancillary imaging test for BDD at our institution. The results of ancillary imaging tests were compared with, the reference standard, the clinical checklist for declaration of brain death. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of different ancillary imaging tests for BDD were performed. Interobserver agreement between two observers was measured using kappa statistics for each of the imaging modalities.RESULTSA total of 74 patients underwent 41 computer tomography perfusion (CTP), 54 CT angiogram, 15 radionuclide scans, 1 cerebral angiogram, 3 magnetic resonance imaging, and 71 nonenhanced CT (NECT) head for BDD. All ancillary tests (except NECT head) showed 100% specificity and PPV. CTP had the highest sensitivity and NPV. All ancillary imaging tests demonstrated very high interrater reliability.CONCLUSIONSThe uses of ancillary imaging tests for BDD are increasing. Within this study's limitations, CTP followed by radionuclide scan were found to be the most accurate and reliable ancillary imaging test for BDD.

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“…Stasis filling is not fully understood but thought to be related to contrast timing and intracranial vessel length. Further questions arise regarding optimal contrast timing and measurements of meaningful perfusion [ 78 ]. Image interpretation often proves difficult, as it can be difficult to determine the specific cerebral vessels most likely to produce an accurate, reliable result.…”

Section: Ancillary Testingmentioning

confidence: 99%

Brain death: a clinical overview

2022

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Brain death, also commonly referred to as death by neurologic criteria, has been considered a legal definition of death for decades. Its determination involves many considerations and subtleties. In this review, we discuss the philosophy and history of brain death, its clinical determination, and special considerations. We discuss performance of the main clinical components of the brain death exam: assessment of coma, cranial nerves, motor testing, and apnea testing. We also discuss common ancillary tests, including advantages and pitfalls. Special discussion is given to extracorporeal membrane oxygenation, target temperature management, and determination of brain death in pediatric populations. Lastly, we discuss existing controversies and future directions in the field.

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CT angiography as a confirmatory test in diagnosis of brain death: comparison between three scoring systems

Cited by 16 publications

References 23 publications

Assessment of Cerebral Circulatory Arrest via CT Angiography and CT Perfusion in Brain Death Confirmation

Assessment of Cerebral Circulatory Arrest via CT Angiography and CT Perfusion in Brain Death Confirmation

The Role of Neuroimaging in the Determination of Brain Death

Brain death: a clinical overview

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